Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion Technique Can Potentially Improve Safety of Interbody Graft Placement

Abstract BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MITLIF) is a well-described procedure with excellent reported outcomes. A modification of interbody graft placement can potentially improve the ease and safety of this procedure. OBJECTIVE To describe a modification of the MITLIF graft placement and retrospectively review our experience including intraoperative and postoperative complications. METHODS Single surgeon, single institution, retrospective analysis of consecutive patients who underwent a modified MITLIF technique between November 2011 and December 2013. Hospital records including operative notes and discharge summaries were reviewed for patient demographics, surgical parameters including operative time and estimated blood loss, intraoperative complications including durotomy/cerebrospinal fluid leak, and postoperative outcomes including time before ambulation and length of stay were all reviewed and analyzed. RESULTS Eighty-three consecutive MITLIF patients; 71 underwent 1-level fusion and 12 had multilevel fusions. Average operative time for single level was 181 min; multilevel was 323 min. Average estimated blood loss was 140 mL. Time before ambulation was <1 d, average length of stay was 1.6 d. There were a total of 4 complications in this series (4.8%). There was zero incidence of durotomy or cerebrospinal fluid leak. CONCLUSION This modified MITLIF technique of maintaining the medial facet prior to discectomy and interbody graft placement can offer the minimally invasive spine surgeons increased assurance while placing the graft and potentially enhance the overall safety and efficacy of this approach. Surgeons utilizing this approach will have little difficulty utilizing this slight modification.